Skip to main content


Changing a trach tube


The information below tells you how to change your child’s tracheostomy (trach) tube. You should not do this alone. You must have another person there to hold the tube in place while you take off the ties and clean your child’s neck. This person also helps while you put in the new tube.

When should I change my child’s trach tube?

That depends on when your child stopped therapy. The table below tells you when to change it.

If your child stopped therapy … Change the tube every …
Less than one (1) year ago 2 weeks
One (1) year ago or more 29 days

Can I use a trach tube more than once?

Yes, you can use Bivona® trach tubes more than once.

  • For a child or newborn, you may clean, sterilize, and use a Bivona tube 5 times.
  • For adults, you may clean, sterilize, and use a Bivona tube 10 times.

How to change a trach tube

Wash your hands with soap and water. Dry them well. See “Do you know…Clean hands.”

Gather your supplies in a clean work area. You will need the items below. The numbers on the list match the items shown in the pictures.

  1. Suction machine, set up and ready
  2. Ambu bag with trach adapter and facemask. (You can use this if needed while suctioning.)
  3. Suction catheter, size ______
  4. Trach, size ________
  5. Trach, half size smaller ___________
  6. Scissors
  7. Sterile gloves
  8. Trach ties
  9. Soapy washcloth
  10. Clean wet washcloth
  11. Clean dry towel
  12. Rolled towel or small blanket

You also need the items listed below. They are not in the picture, but you still need them.

  • Two 10 ml slip tip syringes – If your child has a water-cuffed trach.
  • Cuff inflation syringe – If your child has an air-cuffed trach.
  • Sterile saline wipes
  • Sterile non-woven gauze
  • Sterile water
  • Sterile saline
  • Trach tube cleaning kit (Bivona trach)
  • Oxygen, if needed
  • Second caregiver – Someone who learned to do trach care from a clinical nurse specialist.
Changing the trach tube
cleaning supplies to change trach tube
Supplies for changing trach tube
Place a towel under your child's neck

Wash your hands again with soap and water, and dry them well. Put on sterile gloves. (See “Do You Know…How to put on sterile gloves.”) Suction your child’s trach tube. Have one (1) person hold the child if needed.

Also if needed, place the rolled towel or small blanket under the child’s neck. (See picture at right.) This makes it easier to see the trach area and reach around your child’s neck.

Prepare the new trach by putting the obturator in the trach and attaching the pre-cut trach ties.

While your helper is holding the old trach tube in place, remove the old trach ties and wash your child’s neck with the soapy washcloth and water. Rinse the neck with the clean wet washcloth. Remember to dry your child’s neck well. Use saline wipes and sterile gauze to clean the area around the stoma (opening for the trach). Check your child’s skin for any redness, rash or open areas.




Count to 3 and pull your child’s old trach tube out with a downward motion. The photo at the right shows this.

Pull the old trach tube out




Your helper will quickly put in the new trach tube, pointing it gently downward. (See photo at right.)

Put in the new tube




As you hold the trach tube in place, pull out the obturator right away. (See photo at right.)

Pull out the obturator
Adjust the neckband

Hold the trach in place while your helper fastens the trach ties. Adjust the neckband so that it is not too tight or too loose. You should be able to get one (1) finger under the neckband. (See photo at right.)

Suction your child’s trach again if needed. Throw away your gloves and wash your hands with soap and water.

Changing a trach tube can make your child cough and produce extra mucus during the procedure. This might last several hours. Trach changes also may irritate the airway, causing pink-colored mucus. This should go away in the next several hours. If the mucus is still pink after 2 hours or you have concerns, call your child’s clinical nurse specialist or care team.


If you have questions or concerns about changing a trach, talk to your child’s clinical nurse specialist. A nursing coordinator is always here to answer your questions and address your concerns. Call 901-595-3300 and ask for the nursing coordinator. If you are outside the Memphis area, dial toll-free 1-866-2STJUDE (1-866-278-5833), and press 0 when the call connects.


This document is not intended to take the place of the care and attention of your personal physician or other professional medical services. Our aim is to promote active participation in your care and treatment by providing information and education. Questions about individual health concerns or specific treatment options should be discussed with your physician.

St. Jude complies with health care-related federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.

ATTENTION: If you speak another language, assistance services, free of charge, are available to you. Call 1-866-278-5833 (TTY: 1-901-595-1040).

ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-866-278-5833 (TTY: 1-901-595-1040).

تنبيه: إذا كنت تتحدث باللغة العربية فيمكنك الاستعانة بخدمات المساعدة اللغوية المتوفرة لك مجانا. .يرجى الاتصال بالرقم. 5833-278-866-1  (الهاتف النصي: 1040-595-901-1).